计算机辅助手术系统在先天性胆管扩张症诊治中的应用

Application of Computer Assisted Surgery system in diagnosis and treatment of children with Congenital Biliary Dilatation

目的研究计算机辅助手术系统在小儿先天性胆管扩张症诊断与治疗中的应用价值。方法回顾性分析2013年6月至2015年1月青岛大学附属医院收治的25例先天性胆管扩张症患儿的肝脏64排螺旋CT扫描原始数据,采用计算机辅助手术系统(Hisense CAS)进行肝脏及胆道三维重建,根据三维重建结果进行精准的术前诊断和病理形态分析,以及辅助手术规划,确定最佳手术方案。观察术中所见与术前规划的符合程度、术中出血量、并发症等。结果 25例中,囊肿型14例,梭状型11例;合并肝内胆管扩张18例;少见的复杂胆道畸形3例。肝脏及其内部管道系统的三维模型形态逼真、立体感强,清晰地显示胆管的分布走形及其与肝内三套血管系统的空间位置关系。术前手术方案与实际手术方式符合率为88%(22/25)。术中出血量中位数为12 mL,最少出血量为6 mL。术后无一例出现严重并发症或死亡。结论通过计算机辅助手术系统对CT数据进行三维重建,实现了胆道系统的数字化解剖,并能清晰显示胆道及其周围血管系统的空间位置关系,提高先天性胆管扩张症手术的精准性和手术安全性。

Objetive To study the value of Computer Assisted Surgery system in the diagnosis and treatment of children with Congenital Biliary Dilatation（CBD）. Methods A retrospective analysis of 25 cases of children with CBD who were admitted to the Affiliated Hospital of Qingdao University from June 2013 to January 2015 were collected. The data of 64 - slice spiral computed tomography scan of the patients were analyzed. The liver and bile duct were three dimensionally （3D）constructed. Preoperative diagnosis and surgery procedure were made according to the results of the 3D model of liver and bile duct. The compliance of surgical planning and actual operation, pathological classification, intraoperative blood loss, complications were observed. Resuits Of the 25 patients, 14 were with cystic type, 11 were with spindle type; 18 had intrahepatic bile duct dilatation; 3 had rare malformation complex biliary. The anatomy of intrahepatic and extrahepatic bile duct, dilation and structure of the bile duct, and the spatial relationship with the intrahepatic blood vessels were clearly displayed in the 3D mdoel. The compliance of surgical planning and actual operation was 88% （22/25）. The median volumes of intraoperative blood loss was 12 mL, Minimum amount of blood loss was 6 mL. There were no serious complications or death. Conclusions The three - dimensional reconstruction of CT data by Computer Assisted Surgery system could show the bile duct and adjacent relationship of blood vessel system clearly. It can improve the accuracy and safety in the surgery of CBD.